Multiparameter evidence synthesis in epidemiology and medical decision-making: current approaches

Summary.  Alongside the development of meta-analysis as a tool for summarizing research literature, there is renewed interest in broader forms of quantitative synthesis that are aimed at combining evidence from different study designs or evidence on multiple parameters. These have been proposed under various headings: the confidence profile method, cross-design synthesis, hierarchical models and generalized evidence synthesis. Models that are used in health technology assessment are also referred to as representing a synthesis of evidence in a mathematical structure. Here we review alternative approaches to statistical evidence synthesis, and their implications for epidemiology and medical decision-making. The methods include hierarchical models, models informed by evidence on different functions of several parameters and models incorporating both of these features. The need to check for consistency of evidence when using these powerful methods is emphasized. We develop a rationale for evidence synthesis that is based on Bayesian decision modelling and expected value of information theory, which stresses not only the need for a lack of bias in estimates of treatment effects but also a lack of bias in assessments of uncertainty. The increasing reliance of governmental bodies like the UK National Institute for Clinical Excellence on complex evidence synthesis in decision modelling is discussed.     

Empirical likelihood confidence intervals for the mean of a population containing many zero values

If a population contains many zero values and the sample size is not very large, the traditional normal approximation‐based confidence intervals for the population mean may have poor coverage probabilities. This problem is substantially reduced by constructing parametric likelihood ratio intervals when an appropriate mixture model can be found. In the context of survey sampling, however, there is a general preference for making minimal assumptions about the population under study. The authors have therefore investigated the coverage properties of nonparametric empirical likelihood confidence intervals for the population mean. They show that under a variety of hypothetical populations, these intervals often outperformed parametric likelihood intervals by having more balanced coverage rates and larger lower bounds. The authors illustrate their methodology using data from the Canadian Labour Force Survey for the year 2000.     

Studying the Effects of the Audience on Verbal Behavior

The Analysis of Verbal Behavior -     

Gender and the 'New Paradigm' of Health

This article provides a critical review of literature on the relationship between gender and the 'new paradigm' of health. An overview of the feminist critique of health is given, from the Women's Health Movement of the late 1960s and early feminist debates about medicalisation, to more recent discussions about structural inequalities between men and women, eating disorders, and AIDS. I then go on to explore the feminist response to the so-called 'new paradigm' of health (an approach that emphasises health promotion, individual responsibility for health, and body-monitoring). Arguments that health promotion initiatives target women and confirm their position as principal guardians of health within the family are considered, as well as literature on the breast cancer awareness campaign. I then explore the growing body of literature on masculinity and health, and its account of the relationship between gender and current ideas about healthiness. Finally, I offer up some suggestions for the direction a new feminist critique of health might take.     

Form Perception of Partly Occluded Shapes in 4‐Month‐Old Infants

Two habituation experiments were conducted to investigate how 4‐month‐old infants perceive partly occluded shapes. In the first experiment, we presented a simple, partly occluded shape to the infants until habituation was reached. Then we showed either a probable completion (one that would be predicted on the basis of both local and global cues) or an improbable completion. Longer looking times were found for the improbably completed shape (compared to probable and control conditions), suggesting that the probable shape was perceived during partial occlusion. In the second experiment, infants were habituated to more ambiguous partly occluded shapes, where local and global cues would result in different completions. For adults, the percept of these shapes is usually dominated by global influences. However, after habituation the infants looked longer at the globally completed shapes. These results suggest that by the age of 4 months, infants are able to infer the perceptual completion of partly occluded shapes, but for more ambiguous shapes, this completion seems to be dominated by local influences.     

Risk Compensation or Risk Reduction? Seatbelts,State Laws,and Traffic Fatalities*

Objective. The risk compensation hypothesis suggests that drivers enjoying greater safety will drive more recklessly and thereby impose greater risks on nonoccupants. We provide a test of the risk compensation hypothesis in the context of state seatbelt laws and belt use rates. Methods. Fixed‐effects models with policy and demographic variables are estimated using annual state data from 1985 to 2002 to test the effect of seatbelt laws and seatbelt use rates on logged fatality rates for occupants, pedestrians, motorcyclists, and all nonoccupants in separate models. Results. Contrary to the risk compensation hypothesis, the results indicate that both occupants and nonoccupants enjoy greater safety due to state mandatory use laws and increased safety belt use rates. Conclusion. Overall, seatbelt laws and the higher belt use these laws induce do not increase nonoccupant risk exposure. If anything, these laws and the accompanying increase in belt use result in safer driving behavior.     

Intersensory Redundancy Enhances Memory in Bobwhite Quail Embryos

Information presented concurrently and redundantly to 2 or more senses (intersensory redundancy) has been shown to recruit attention and promote perceptual learning of amodal stimulus properties in animal embryos and human infants. This study examined whether the facilitative effect of intersensory redundancy also extends to the domain of memory. We assessed bobwhite quail chicks' ability to remember and prefer an individual maternal call presented either unimodally or redundantly and synchronously with patterned light during the period prior to hatching. Embryos provided with unimodal auditory exposure failed to prefer the familiar call over a novel maternal call postnatally at 48 hr and 72 hr following exposure. In contrast, embryos provided with redundant, synchronous audiovisual stimulation significantly preferred the familiar call at 48 hr following exposure, but not at 72 hr. A second experiment provided chicks with a single 10‐min refamiliarization with the familiar call at either 48 hr or 72 hr following hatching. Chicks given only unimodal auditory exposure prior to hatching did not appear to benefit from this brief postnatal refamiliarization, showing no preference for the familiar call at either 72 or 96 hr. Chicks that received redundant audiovisual stimulation prenatally showed a significant preference for the familiar call (following the brief reexpo sure 24 hr earlier) at both 72 and 96 hr of age. These results are the first to demonstrate that redundantly specified information is remembered longer and reactivated more easily than the same information presented unimodally. These findings provide further evidence of the salience of intersensory redundancy in guiding selective attention and perceptual learning during early development.     

WOMEN'S WORK:

We use in-depth interviews, participant observation, and document analysis to examine women's involvement in the Gulf War Illness movement. We find that women's cumulative grievances of health concerns, financial hardships, and emotional problems opened them to movement recruitment as they surfed the Internet for information and support. The movement's division of labor was influenced not by gender but by health status. Women used the Internet to provide medical information and emotional support to geographically dispersed veterans. Activism transformed women activists by endowing them with a sense of empowerment and a somewhat broadened concern for social justice. Although their transformations disposed the women to become active on related issues, it did not extend to concerns about gender discrimination. We suggest that the next research step is to investigate gender differences in movement processes by surveying activists across a variety of movements to test propositions and to identify the characteristics of other social contexts that structurally instigate a departure from traditional gender roles.